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Home My WebLink AboutPermit Building 2007-5-25 Status Issued 225 Fifth Street, Springfield, OR . 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ,CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: cOM2007-00600 ISSUED: OS/25/2007 APPLIED: 04/25/2007 EXPIRES: 11/25/2007 VALUE: $ 333,990.00 SITE ADDRESS: 6336 FOREST RIDGE DR ASSESSOR'S PARCEL NO.: 1702343408700 SPRINGFIE TYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single family residence - Mt Gate 1st Add lot 77 Owner: HUMPHREYS BRIAN M & WENDI Address: 901 S 72ND ST SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Residential Contractor Type Contractor License Expiration Date Phone General OWNER Electrical OWNER Mechanical SUNSHINE HEATING & AIR 127145 01/25/2008 503-720-8410 Plumbing DONALD CLEWIS 33076 06/10/2007 541-688-1931 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 U VB Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 18.00 13.00 10.00 0.00 Subdivision Not Accepted Street Improvements: Storm Sewer Available: Special Instruction: 3 BUILDING INFORMATION I # of sN-QJ;1 C E: 2 Lot Size: Heiglijt~'~ft~Rmff SHALL ~M~E I~tt ~~I*l\19~: Type /1.. V . < 2m1flbbr' Water~r~RIZED UND~eI ~ PE~~ < B)!,~Q.lnt; RangG@~iMENCED OR IS AfiMDONhl}'fMrage/Carport Ener~atffiO DAY PERIOlf,ath 1 Sq Ft Other: Sprinkled Building: n/a Occupant Load: I DEVELOPMENT INFORMATION I 12,418 1,743 1,155 708 252 REQUIRED PARKING 2 Overlay Dist: Hillside Total: # Street Trees Rqd: 3 es .JEutrecapped: Paved ]~rNeQlq1J'iON:Oregon la'^Ve~qUlr ;'dtflR~ct: % of lflt'~'W€ir~ adopted by~!oOregon t f r LflcEition Center. Those rules are sa 0.:. \Jot_ ..... ~~;.~ S i'"lw,:,' 'gh (")AR 952-00 I PUBLIC I~~~9'tl;W~btain copies of the rules \ o I ,i \lln the center .Sitl\m~kttr~ t~I~~hO~. eEl Q f the OrE:tQon Utility~otlflcatlon Curbside 5' nultlber or '_ ~ ~R~~~~~.ns: To Storm Sewer Fully Improved No Notes: Storm to designated lateral. JLP APP 5/11/07 Pae:e 1 of 5 Status Issued .ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2007-00600 ISSUED: OS/25/2007 APPLIED: 04/25/2007 EXPIRES: 11/25/2007 VALUE: $ 333,990.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion ~ A.C. - Residen Deck/Balcony Dwelline:s Garae:e AC - Residential Deck V Wood Frame Garae:e $ Per Sq Ft or multiplier $4.00 $19.00 $103.00 $27.00 Square Footage or Bid Amount 2,898.00 252.00 2,898.00 708.00 Value Date Calculated Description Type of Construction Total Value of Project $11,592.00 $4,788.00 $298,494.00 $19,116.00 $333,990.00 OS/21/2007 OS/21/2007 04/25/2007 04/25/2007 ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $828.20 4/25/07 1200700000000000459 -Mechanical Issuance Fee- $10.00 5/25/07 1200700000000000630 + 10% Administrative Fee $217.71 5/25/07 1200700000000000630 + 5% Technology Fee $117.61 5/25/07 1200700000000000630 + 8% State Surcharge $158.73 5/25/07 1200700000000000630 3 Baths One & Two Family $306.00 5/25/07 1200700000000000630 Addressing Assignment $31.00 5/25/07 1200700000000000630 Building Permit $1,326.15 5/25/07 1200700000000000630 Curbcut Permit $40.00 5/25/07 1200700000000000630 Curbcut Permit $80.00 5/25/07 1200700000000000630 Dryer Vent $6.00 5/25/07 1200700000000000630 Exhaust Hoods $9.00 5/25/07 1200700000000000630 Fire SF Fee - Residential $192.90 5/25/07 1200700000000000630 Fireplace (Listed) $15.00 5/25/07 1200700000000000630 Furnace - up to 100,000 btu $12.00 5/25/07 1200700000000000630 Gas Outlets 1-4 $4.00 5/25/07 1200700000000000630 Heat Pump $12.00 5/25/07 1200700000000000630 Mountaingate Impervious Area $1,204.19 5/25/07 1200700000000000630 Plan Review Major - Planning $198.00 5/25/07 1200700000000000630 Plan Review Residential $33.80 5/25/07 1200700000000000630 PW Disc - 2nd Permit $-30.00 5/25/07 1200700000000000630 Residence Wiring 1000 Sq Ft $106.00 5/25/07 1200700000000000630 Residence Wiring Ea Addtl 500 $114.00 5/25/07 1200700000000000630 Sanitary Sewer - Improvement $672.88 5/25/07 1200700000000000630 Sanitary Sewer - Reimbursement $884.90 5/25/07 1200700000000000630 SDC MWMC Administration $10.00 5/25/07 1200700000000000630 SDC MWMC Improvement $961.52 5/25/07 1200700000000000630 SDC MWMC Reimbursement $91.61 5/25/07 1200700000000000630 SDC Sanitary/Storm Admin $176.86 5/25/07 1200700000000000630 SDC Transpo Admin $65.69 5/25/07 1200700000000000630 SDC Transpo Improvement $836.32 5/25/07 1200700000000000630 SDC Transpo Reimbursement $189.58 5/25/07 1200700000000000630 Sidewalk Permit $80.00 5/25/07 1200700000000000630 Pae:e 2 of 5 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Temp Power 200 amps or less Vent Fan Willamalane Single Family $50.00 $24.00 $2,303.00 Total Amount Paid $11,338.65 I Plan Reviews I Initial Review Plan nine: Review 04/27/2007 04/27/2007 04/27/2007 05/18/2007 APP APP Public Works Review Public Works Review 04/27/2007 05/11/2007 04/30/2007 05/09/2007 WI 10 Public Works Review 05/11/2007 05/11/2007 APP Public Works Review 05/03/2007 05/03/2007 WE Structural Review 04/27/2007 05/08/2007 APP CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: cOM2007-00600 ISSUED: OS/25/2007 APPLIED: 04/25/2007 EXPIRES: 11/25/2007 VALUE: $ 333,990.00 5/25/07 5/25/07 5/25/07 1200700000000000630 1200700000000000630 1200700000000000630 NJM TAJ Place organge construction fencing to the drip lines of trees # 2,9,3, and 4. Follow tree preservation guidelines attached to the permit. Plant native street trees from the list on pg 6-4 of the street tree handout. Rcvd by PW 4/30/07 Rcvd required info from applicant. Will process this week. JLP 10 5/9/2007 Storm to designated lateral. JLP APP 5/11/07 Owner's phone number not in system or phone book. Rcvd from plumber 729-1489. Proposed plan shows drive exceeding 30ft. Cld & spoke w/Brian he will bring in new site plan and application for overwidth. JLP WE 4/3/07 Engineering provided for retaining walls, shearwalls, beam size and locations, also all hold downs and type are included in engineering. ROOF SHEA TING INSPECTION REQUIRED BY ENGINEERING. JLP JLP JLP JLP RJB To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. ~eouire<Unsnections I Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. Rough Mechanical: Prior to Cover Pae:e 3 of 5 2ITY OF SPRINGFIELD' Building/Combination Permit Status Issued PERMIT NO: cOM2007-00600 ISSUED: OS/25/2007 APPLIED: 04/25/2007 EXPIRES: 11/25/2007 VALUE: $ 333,990.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Sidewalk - Curbside: After forms are erected but prior to placement of concrete. Curbcut - Overwidth: After forms are erected but prior to placement of concrete. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Roof Sheathing/Nailing: Before covering sheathing with finish material. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Final Building: After all required inspections have been requested and approved and the building is complete. Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill. Underfloor Plumbing: Prior to insulation or decking. Underfloor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and including required testing. Shower Pan. Prior to covering and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance. Pae:e 4 of 5 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2007-00600 ISSUED: OS/25/2007 APPLIED: 04/25/2007 EXPIRES: 11/25/2007 VALUE: $ 333,990.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Rough Gas: After line is installed and required testing and capped if not attached to an appliance. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all tim"5r:r;:on~ / O??~O r Owner or Contractors Signature Date Pae:e 5 of 5 C,TY OF Spf~GF'ELD SYSTEMS DEVELOPMEN) JOURNAL OR JOB NUMBER: COM2007-00600 NAME OR COMPANY: Brian Humphrey's LOCATION: 6336 Forest Ridge Dr TAX LOT NUMBER: Lot #77 Mt Gate 1 st Add DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS ] BUILDING SIZE (SF: 2568 JRKSHEET ]. STORM DRAINAGE. DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x . COST PER S.F. CHARGE I 3588.00 . $0.336 = $1,204.19 I RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F. x COST PER S.F. x DlSCOUNT RATE I I 0.00 $0.336 50% I ITEM 1 TOTAL - STORM DRAINAGE SDC $1,204.19 I 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBER OF DFU's I x .I 34 . B. IMPROVEMENT COST: I NUMBER OF DFU's I x I 34 I COST PER DFU $26.03 $19.79 LOT SIZE (SF): 12418 r.rJ ~ o u ~ P-l If-< r.rJ ...... o ~ DlSCOUNT $0.00 $1,204.19 1070 $884.90 109] $672.88 1092 ITEM 2 TOTAL ~ CITY SANITARY SEWER SDC =1 $1,557.78 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE x I NUMBER OF UNITS I x I COST PER TRIP I x INEW TRIP FACTOR i 9.57 I ] I I $]9.81 I 1.00 $189.58 ]093 B. IMPROVEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS x I COST PER TRIP x INEWTRIPFACTOR I 9.57 I ] 1 $87.39 I 1.00 $836.32 ]094 ITEM 3 TOTAL - TRANSPORTATION SDC =1 $1,025.90 4. SANITARY SEWER - MWMC A.REIMBURSEMENT COST: NUMBER OF FEU's x COST PER FEU 1 $91.61 B. IMPROVEMENT COST: INUMBER OF FEU's x I I I COST PER FEU I $961.52 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = 1 SUBTOTAL (ADD ITEMS 1,2,3, & 4) ~ 1 5. ADMINISTRATIVE FEE: I SUBTOTAL x ADM. FEE RATE I $4,851.00 5% TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: = $91.61 1054 = $961.52 ]055 $0.00 I 1054 j $10.00 11056 $1,063.13 $4,851.00 . , CHARGE $242.55 176.86 1079 $65.69 1078 , , =, I TOTAL SDC CHARGES $5,093.55 Jeff Prociw. 5/11/2007 PREPARED BY DATE DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIV ALENT ~ DRAlNAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBATHTUB 2 0 3 = 6 IDRINKING FOUNTAIN 0 0 1 0 I FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE I OIL I SOLIDS I ETC. 0 0 3 = 0 I INTERCEPTORS FOR SAND I AUTO WASH I ETC. 0 0 6 = 0 ILAUNDRY TUB 2 0 2 = 4 I CLOTHES WASHER I MOP SINK 1 0 3 = 3 ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRIG I WATER STATION I ETC. 0 0 1 = 0 IRECEPTOR FOR COM. SINK I DISHWASHER I ETC. 1 0 3 = 3 ISHOWER, SINGLE STALL 1 0 2 = 2 I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3 SINK: COMMERCIAL BAR 0 0 2 = 0 SINK: WASH BASIN/DOUBLE LA V A TORY 1 0 2 = 2 SINK: SINGLE LAVATORY/RESIDENTIAL BAR 2 0 1 = 2 URINAL, STALL I WALL 0 0 5, = 0 TOILET, PUBLIC INSTALLATION 0 0 6 = 0 TOILET, PRIVATE INSTALLATION 3 0 3 = 9 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 34 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwell~~~ unit (20 DFlJ~) set at ]67 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR CREDIT RATE/$] ,000 ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? 2 BEFORE] 979 $5.29 (Enter ] for Yes, 2 for No) ]979 $5.29 IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? 2 ]980 $5.19 (Enter] for Yes, 2 for No) ]98] $5.12 BASE YEAR ]979 ]982 $4.98 ]983 $4.80 CREDIT FOR LAND (IF APPLICABLE) ]984 $4.63 VALUE I 1000 CREDIT RATE ]985 $4 .40 $0.00 x $5.29 = 1 $0.00 ]986 $4.07 ]987 $3.67 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) 1988 $3.22 VALUE I ]000 CREDIT RATE 1989 $2.73 $0.00 x $5.29 0 I 1990 $2.25 I 1991 $1.80 1992 $1.59 TOTAL MWMC CREDIT = $0.00 1993 $1.45 ]994 $1.25 ]995 $1.09 1996 $0.92 1997 $0.72 ]998 $0.48 1999 $0.28 2000 $0.09 2001 $0.05 ZON t~ INITIALS _~ -J~ ~ DATE ~;I'(J-r ~~~~~;~~ S;;=~; :;;~;;~;;~;;3753 0 FAX: (541)726-3689 ~ /cSOURCE \l ~ City Job Number COMZOO-'- 00600 Date 'f/Z S- D7 1. LOCATION OF INSTALIATI01J!53\P. ~~P'"fTE FEE SCHEDULE BELOW tOI 77-,_ ,.P0If,ViJ1-l:.,J 6-4'/C .1'>';- At)tJti7'-~tJ(~ LEGAL DESCRIPTION: A. New Residential- Single or Multi-Family per dwelling unit. 51,;..;(~U-- U:"klA.._t{~, ;2(;"51 (}t.:/,,"-l;'IA-L ;Z:E:~:~: aeo'JU<~:'-. Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. CONTRACTOR INST.ALLATION ONLY Address I / Phone / / City Expiration Date ~ s;gna/~ Sup,,,,;'",g EI"trio;au Inspection Request: 726-3769 Service Included ~.Rf r"- 1000 sq. ft. or less ~v ''\ \ Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder La $106.00 \U..a()D $ 19.00 \\~ JV $50.00 B. Services or Feeders - Installation, Alterations or Relocation: 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/V olts Reconnect Only )( \'~. - Lit. c,~e~\!'j{~rn~~fV\~toWf1Wters \ ti\~ d:R~~~ 5\1 [ IS ERM\1 \5 N01 1\\1"1,. \-1\.0. \\\l.f:U UMU~\\J~n~~wratWIf. ftrnRelocation .." ()Q.. \c:.~BA DUNtU. UIT \/ COIViiV\\.NGi:\J ~(l)V'A' sor ess'. ~, ,I\J\V HW \) I\Y \2liF~ ps to 400 Amps ' 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extensio.I6S~~~VU tu 1\ laW I. Ut\\ih One Cir~'~'rOmg.J" ' e oreCOO -$ 43.00 . ;;.. tT\'kll.~J' .. '..,<>l",,;-;od.U\/ \h 'th' ,'1..'\ S8"\. lot . i .., - Dae'n "Q ~\ (.)\'J~IT ()r wJ""~l;l.' eI.1 v - 12' _' J 'o\'~fc~\~r i~f.ef~\i~5e ~V~ ;, NiJ, Q5Z43.00 Owners Name l/?lA.,..,J r l(;v.O//Tl.e1S') . t\i\cation r\O'iQthfOU91I 0, ,he n\\~;:; oJ ,; ~o -1).A01-v \es Ql " Address ::}/CJb 'c... I -sr/lt.c / \,~,.~~~~a'fle~la~~e.trM'lf~Ve?tn6~ -Each Installation . "O~ "'(0...... n"e:,'~n\af. \No~e. ~"N No~itiC3'.\ot' City 4~ L\.J&FiCRO Phone Z}I f ; 72 'Ut/fi'I; li'~i<<'I t~~1WnOfegon \.)t\\i ~) $ 50.00 -, 1~~anJhe" tl~ting ~M"; .'').'~?- -' $ 50.00 OWNER INSTALI~ATION Limited Energy/Residential $ 25.00 The installation is being made on property I own which Limited Energy/Commercial $ 45.00 is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges . oanatu co "-7 "... :://,/",;.. 4. SUBTOTAL OF ABOVE ~fO, -:;r-;i ..??-7. ./V. --- 8% State Surcharge ..~ , .,.., 10% Administrative Fee 1 f.1) 5% Technology Fee ~ ~ :?() .'\~)V TOTAL $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $ 50.00 $ 69.00 $100.00 5)9J Shared Dlive(T:)/Building Fonns/Electrical Pennit ApPlication 8-06.doc Construction. Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309~SOS2 Phone: SQ3-:37S-4621 Web Address: www.ccb.state.or.us Permit#.: COV1/lZ-e- 7-c06()O Address: b ~ b.~' ~ (J C-(j ~c( Date: :5k}~-1 / t Issued by: Statement: Information Notice to Property Owners About Co-nstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical and' plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Filt'in the appropriatt~bl~s and initial boxes 1 ~d 2, and either b()x 3A or 3B: ~ 1. , - I own, reside in, or will reside in the completed structure.' .' ~ . I unders~and that 1 must become iicensed as a construction contractor.-ifthe structure is sold or . ~ - -- offered ~orsale before or on completion. _ - . . . o ,3A. My general contractor is (Name) (CcB #) . ''I will instruct my general contractor that all subcontractors who work on the stru~ture must be licensed with the Construction Contractors Board. ~. OR G 3B. I will be my own general contractor. . If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the cCB ,and will immediately notify the office issuing this building permit of the- name of the cOIltractor. . I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. 53~/ . {))'z.c;u 9- '(sIgnature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 ___ . I,Actri1(g:~ils~ xouJ(Own ...)~ l ~ : -1~. -'," /~) ~~ j -1 .:::...)...?, '. '. 'jNFORMATI6~N OWNERS . '\ \. ~.\ ''>'<\''" ' ABOUrCONSTRUCTION'RESPONSIBllITIES .' ., . - - C -. 1"" . ~ "- i . ~ '.' ." " . . If you are as . structure, you can .; " Contractor? " " f Information Notice to Property Contractors Board in accordance about Construction Responsibilities was developed by the ORS 701.055(5), passed by the 1989 Oregon Legislature. " . , own contractor to construct a.ncw home or a substa~tiai improvement to art existing many problems by fol1ow{ngresponsibiiities and concerns. Employer it;l.stances, ruled to be an "employer" not licensed with the. Construction improvement of a iesidentialstructur~: you contrac;t with will be "employees" if Board to 40 labor constructins or to assist in the you must comply with foU9wing: ~ . , '. '- . . .~;.. You on . -' . -.. - ( , " . Code coverage for that must Make income taxes from employee wages at the time even don't actually withhold the tax from your at 503':;378-4988. .. . Tax: As an employer; you' For more information, to pay a tax for unemploymerit'insurance purposes' . > Employment Department at 503-947-1488. , :. ." -----:..... '~umber for both Or~gel). Withholding and) or w\'v"\v.dor.state.or.us/fonnsouv.htmll for the "'J .~. _ .' , - ~ Identification Number. (a IN) " Tax. To file for a BIN, Insurance: As an yompensa.tion ips"!ll'unce subj ecf to penalties 'and call the Workers' to the Oregon Workers' Compensation Law, . If you fail to. obtain workers' compensation cosis if one of YOUr "employees is injured on the at .the Department of Consumer and" Business 15. " Service: 'As an employer, the tax payment even if you or visit theinvebsite atwww "" ... "~ federalincoine tax: employees' wages'._") withhold the tax. For a Federal EIN number, can the for resolving any failure to meet code the permit hol~er for h.~ ~rought ,to your attention namage"insuunce: ," and omissions such as are ,. agent to see if you baye adequate' insu~nce over spray, water damage.from pipe punctures; fire ~r - '~_ . " r ',\. .........~.. c'> ',> \,' '.~~. ,have sufficient time:to , , , " \',,< .....-.."'J. ~.... ... your . ~~s~ - " .'.' contractor, t~ co~rdi~~te the work of rough-in so they can perform the required inspections. sure you the skins .to ' "as notify building officials as caB the Construction 97309-5052. (503-378-4621) or the agency at 06-01-04 Willamalane Park & Recreation District Job. NO.C-'" (jJG1 cro SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2007 NAM~~l('Uf\ t\ lJ"ll"'?,e~J{~ PHONE: /2.<1 - \ '-t&'~ ADDRESS:\ \~(\ Co' 'S\ CITySP:t&-.- STATE: Cf2zIP:3'4:f7 LOCATION OF PROPOSED BUILDING SITE:~ Street Address: (or:s 3y, ~~s\ (2., ;6-2 ~ Plat NameffirJl~ '5{'l;-\e,..- Tax Lot Number: \1 a~ 3~ 3 c..t- 0157aD 1. DEVELOP~ENT TYPE (Check appropriate dwelling{s). Dwelling type definitions are on the back. ) A. Sinale-Familv Detached NO. OF UNITS X $2,303 per unit = o..::J $~303. B. Sinale-Familv Attached NO. OF UNITS X $2,426 per unit = $ C. Multi-Familv Aoartment NO. OF UNITS X $2,032 per unit = $ D. Sinale Room Occuoancv NO. OF UNITS X $1,016 per unit = $ E. Accessorv Dwellina Unit NO. OF UNITS X $1,151.50 per unit = $ $ ;:)303.~ WILLAMALANE SDC 2. SDC CREDIT (If applicable) SDC payer must fumish proof of Willamalane Credit approval.) $ (6 3. TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced for Credit) oa $ ;;)303. 5 / 2~ Date 07' 5 DEVELOPMENT TYPE DEFINITIONS1 Single Family Detached Dwelling Unit A building or a portion of a buildin:g consisting of one or more rooms including sleeping, cooking, and plumbing facilities arranged and designed as permanent living quarters for one family or household; and not attached to any other dwelling unit or building. This definition inCludes manufactured housing. Single Family Attached Dwelling Unit A portion of a building consisting of one or more rooms including sleeping, cooking, : and plumbing facilities arranged and designed as permanent living quarters for one family or household; and which is attached to one or more dwelling units by one or more common vertical walls. This definition also includes, but is not limited to "duplex", "zero lot line dwelling", "townhouse", and "row house". With the exception of duplexes, Single Family Attached Dwelling Units typically are separately owned. Multi-Family Dwelling Unit A portion of a building consisting of one or more rooms including sleeping, cooking, and plumbing facilities arranged and designed as permanent living quarters for one family or household; and which is attached to two or more dwelling units by one or more common vertical walls. Typically, the units are in an apartment building or complex, and are not separately owned. Single Room Occupancy Dwelling Unit A portion of a building consisting of one or more rooms including sleeping facilities with ? shared or private bath, and shared cooking facilities and shared living/activity area. This definition also includes, but is not limited to "assisted living facility." Single room occupancy dwelling units shall be charged at one-half the multi-family dwelling unit SDC rate. Accessory Dwelling Unit A secondary, self-contained dwelling that may be allowed only in conjunction with a detached single-family dwelling. An accessory dwelling unit is subordinate in size, location, and appearance to the primary detached single-family dwelling. An accessory dwelling unit generally has its own outside entrance and always has a separate kitchen, bathroom and sleeping area. An accessory dwelling unit may be located within, attached to, or detached from the primary single-family dwelling. Accessory dwelling units shall be charged at one-half the single family detached dwelling unit SDC rate. Updated 2/20/07 1 From the WPRD Parks and Recreation SDC Resolution No. 06-07-6. October 10, 2006 6 ,.' cj*" of Springfield Official Receipt L lopment Services Department Public Works Department 225 F~ft~ Street Sprh:igfield, Oregon 97477 541-'726..3759 Phone Job/Journal Number COM2007-00600 ,> COM2007-00600 COM2007-00600 COM2007 -00600 COM2007-00600 COM2007-00600 COM2007 -00600 CO M2007 -00600 COM2007-00600 COM2007 -00600 COM2007-00600 COM2007-00600 COM2007-00600 CO M2007 -00600 COM2007-00600 COM2007 -00600 COM2007 -00600 COM2007-00600 CO M2007 -00600 COM2007 -00600 COM2007-00600 COM2007-00600 COM2007-00600 COM2007-00600 COM2007-00600 CO M2007 -00600 COM2007-00600 COM2007-00600 COM2007-00600 COM2007-00600 COM2007-00600 CO M2007 -00600 COM2007-00600 COM2007-00600 COM2007-00600 Payments: Type of Payment Check cReceintl , RECEIPT #: 1200700000000000630 Description Temp Power 200 amps or less Addressing Assignment WilIamalane Single Family 3 Baths One & Two Family Furnace - llP to 100,000 btu Vent Fan Exhaust Hoods Gas Outlets )-4 Fireplace (Listed) Heat Pump -Mechanical Issuance Fee- Dryer Vent Curbcut Permit' Curbcut Permit Sidewalk Permit PW Disc - 2nd Permit Mountaingate Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Tran'spo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin SDC Transpo Admin Plan Review Major - Planning Plan Review Residential Building Permit Fire SF Fee - Residential Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Date: OS/25/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received Paid By BRIAN HUMPHREYS djb 1004 Page I of I In Person Payment Total: 11:11:41AM Amount Due 50.00 31.00 2,303.00 306.00 12.00 24.00 9.00 4.00 15.00 12.00 10.00 6.00 40.00 80.00 80.00 (30,00) 1,204.19 884.90 672.88 189.58 836.32 91.61 961.52 10.00 176.86 65.69 198.00 33.80 1,326.15 192.90 106.00 114.00 117.61 158.73 217.71 .$10,510.45 Amount Paid $10,510.45 $10,510.45 5/25/2007